Provider Demographics
NPI:1376580977
Name:LANCASTER, ALISA R (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:R
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5400 TRINITY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6001
Mailing Address - Country:US
Mailing Address - Phone:919-851-2174
Mailing Address - Fax:919-854-7774
Practice Address - Street 1:100 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8453
Practice Address - Country:US
Practice Address - Phone:919-460-0993
Practice Address - Fax:919-481-3952
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7950670Medicaid
NC50670OtherBCBS
NC50670OtherBCBS